Hemicrania Continua Headaches Symptoms and Treatment

A hemicrania continua headache is a sub-type of chronic headache experienced by migraine sufferers. Most patients with hemicrania continua headaches report pain present for more than three months, with exacerbations of moderate or greater intensity.

By definition, hemicrania continua occurs on just one side of the head. The chronic pain is generally continuous and fluctuates in intensity with few breaks in between. The pain you experience is exacerbated by sharp, jabbing pain on the same side. You may even experience pain that moves between each side of the head during one headache episode which researchers have found may occur.

Woman with headache
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Symptoms, Prevalence, and Diagnosis

In addition to chronic pain, symptoms of the disorder include:

  • Runny nose
  • Tearing and redness of the eyes
  • Sweating
  • Drooping eyelids
  • Nausea
  • Vomiting
  • Sensitivity to light

It is unknown how prevalent hemicrania continua headaches are among the public. However, it is known that chronic headaches affect 4% to 5% of the general population.

Other chronic headache sub-types include migraine, chronic tension-type headache, and new daily persistent headache.

Researchers have found that hemicrania continua headaches, like migraine headaches, are more common among women. In addition, research indicates that exercise and alcohol consumption can worsen hemicrania continua headache symptoms.


The most commonly prescribed treatment for hemicrania continua is indomethacin, an anti-inflammatory oral medication. Hemicrania continua headaches are referred to as indomethacin responsive, meaning in most cases the symptoms are eliminated after several doses of the drug.

However, as with other anti-inflammatory medications, the side effects of indomethacin often preclude long-term usage. In fact, 25% to 50% of patients on indomethacin therapy eventually develop gastrointestinal side effects commonly caused by this medication, including abdominal pain, stomach ulcers, and intestinal bleeding. Other side effects may include excessive fatigue, unexplained bruising or bleeding, blurred vision, ringing in the ears, and chronic constipation.

Other Treatment Options

Although no medication has been proven to treat hemicrania continua headaches as effectively as indomethacin, new research has uncovered other treatment options. Among those most commonly use alternative therapies include cyclooxygenase-2 inhibitors, gabapentin, melatonin, topiramate, verapamil, onabotulinumtoxinA, occipital nerve stimulation, and vagus nerve stimulation. 

Some case studies have demonstrated that the herbal supplement melatonin could be a promising alternative therapy. Available over-the-counter, melatonin has a chemical structure similar to indomethacin, but it is found naturally in the body. However, the herbal supplement is not subject to approval by the FDA and, as with any medical condition, patients should consult their healthcare provider before beginning any therapy.

Researchers have also found the prescription drug topiramate to be a promising treatment. Topiramate is an anticonvulsant medication that reduces irregular brain activity. Although several small case studies have found the medicine beneficial, larger studies are needed to learn whether the benefits of the drug outweigh the potential side effects, which include dizziness, inability to concentrate, confusion, increased risk of kidney stones, and increased risk of osteoporosis. As with any medication regimen, care should be taken to follow your healthcare provider's orders.

6 Sources
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  1. NINDS. Hemicrania Continua.

  2. American Migraine Foundation. What to know about hemicrania continua.

  3. MedlinePlus. Indomethacin.

  4. Baraldi C, Pellesi L, Guerzoni S, Cainazzo MM, Pini LA. Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisalJ Headache Pain. 2017;18(1):71. doi:10.1186/s10194-017-0777-3

  5. Rozen TD. How effective is melatonin as a preventive treatment for hemicrania continua? A clinic-based studyHeadache: The Journal of Head and Face Pain. 2015;55(3):430-436. doi:10.1111/head.12489

  6. Cohen AS, Goadsby PJ. Paroxysmal hemicrania responding to topiramate. J Neurol Neurosurg Psychiatry. 2007;78(1):96-7. doi:10.1136/jnnp.2006.096651